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Comment. Epstein-Barr virus–associated B-cell lymphomas have been mainly reported in immunosuppressed patients such as those with human immunodeficiency virus infection, organ transplantation, or methotrexate therapy for rheumatoid arthritis. Epstein-Barr virus–positive DLBCL of the elderly is defined as a lymphoproliferative disorder arising in patients without predisposing immunodeficiency, including human immunodeficiency virus and human T-cell lymphoma virus 1 infection, a history of chemotherapy or radiotherapy, and autoimmune disease, and is thought to result from immunological deterioration associated with aging. According to the World Health Organization classification, EBV-positive DLBCL of the elderly is a rare DLBCL that accounts for 8% to 10% of DLBCL among patients without predisposing immunodeficiency in Asian countries. Interestingly, EBVpositive DLBCL of the elderly frequently involves extranodal sites. Most patients with extranodal disease also have nodal disease. In fact, 70% of patients have extranodal disease affecting sites such as the skin, lung, tonsils, or stomach, while 30% of patients have lymph node involvement alone. However, no case of ocular involvement, which is an extranodal site, has been reported. To our knowledge, our case is the first report of EBV-positive DLBCL of the elderly involving the eyelid and orbit. Epstein-Barr virus–positive DLBCL of the elderly with ocular involvement is totally distinct, both clinically and pathologically, from extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, an indolent tumor that is the most common form of lymphoma in the orbital region. Although relatively uncommon, EBVpositive DLBCL of the elderly should be considered in the differential diagnosis of ocular lymphoma since it needs to be treated appropriately as a highly aggressive lymphoma.

Severe Retinal Vascular Infarction After Photodynamic Therapy With Verteporfin Using the Standard Protocol